scholarly journals Results of Spinal Fixation in Thoracolumbar Spine fractures with Spinal Cord Injury using the ASIA Impairement Scale

2016 ◽  
Author(s):  
Dr Arnab Sinha ◽  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Thoracolumbar Spine ◽  
Spine Fractures ◽  
Spinal Fixation ◽  
Cord Injury ◽  
Thoracolumbar Spine Fractures

scholarly journals Timing of surgery in thoracolumbar trauma: is early intervention safe?

2014 ◽  
Vol 37 (1) ◽  
pp. E7 ◽  
Author(s):  
Christopher Paul O'Boynick ◽  
Mark F. Kurd ◽  
Bruce V. Darden ◽  
Alexander R. Vaccaro ◽  
Michael G. Fehlings
Keyword(s):  
Spinal Cord ◽  
Posterior Instrumentation ◽  
Thoracolumbar Spine ◽  
Spine Fractures ◽  
Thoracolumbar Fractures ◽  
Surgical Timing ◽  
Cord Injury ◽  
Thoracolumbar Spine Fractures ◽  
Support Cost ◽  
Early Fixation

The understanding of the optimal surgical timing for stabilization in thoracolumbar fractures is severely limited. Thoracolumbar spine fractures can be devastating injuries and are often associated with significant morbidity and mortality. The role of early surgical stabilization (within 48–72 hours of injury) as a vehicle to improve outcomes in these patients has generated significant interest. Goals of early stabilization include improved neurological recovery, faster pulmonary recovery, improved pain control, and decreased health care costs. Opponents cite the potential for increased bleeding, hypotension, and the risk of further cord injury as a few factors that weigh against early stabilization. The concept of spinal cord injury and its relationship to surgical timing remains in question. However, when neurological outcomes are eliminated from the equation, certain measures have shown positive influences from prompt surgical fixation. Early fixation of thoracolumbar spine fractures can significantly decrease the duration of hospital stay and the number of days in the intensive care unit. Additionally, prompt stabilization can reduce rates of pulmonary complications. This includes decreased rates of pneumonia and fewer days on ventilator support. Cost analysis revealed as much as $80,000 in savings per patient with early stabilization. All of these benefits come without an increase in morbidity or evidence of increased mortality. In addition, there is no evidence that early stabilization has any ill effect on the injured or uninjured spinal cord. Based on the existing data, early fixation of thoracolumbar fractures has been linked with positive outcomes without clear evidence of negative impacts on the patient's neurological status, associated morbidities, or mortality. These procedures can be viewed as “damage control” and may consist of simple posterior instrumentation or open reductions with internal fixation as indicated. Based on the current literature it is advisable to proceed with early surgical stabilization of thoracolumbar fractures in a well-resuscitated patient, unless extenuating medical conditions would prevent it.

Assessment and immediate management of spinal cord injury

2016 ◽  
Author(s):  
Simon Finfer ◽  
Oliver Flower
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Motor Vehicle ◽  
Spinal Injury ◽  
Thoracolumbar Spine ◽  
X Rays ◽  
Cervical Spine Injuries ◽  
Cord Injury ◽  
Thoracolumbar Spine Fractures ◽  
Cervical Injuries

Spinal cord injury is a potentially devastating injury, which may occur in isolation, but more commonly occurs in the setting of multiple injuries. Motor vehicle accidents and falls are the most common causes. Depending on the level of the injury and its completeness, patients may be left with paraplegia or tetraplegia. The injury may be immediately obvious based on history and clinical examination, but may have to be actively excluded in multiply-injured patients. Thoracolumbar spine fractures are almost always evident on plain X-rays, whereas computed tomography (CT) or magnetic resonance imaging (MRI) is frequently required to exclude cervical spine injuries. Immediate management should be directed at the detection and treatment of life-threatening injuries. Patients should be transferred to a facility specializing in the management of spinal cord injury as soon as feasible. Acute management of the spinal injury itself is largely supportive and aimed at avoiding preventable secondary injury. Respiratory complications are common, and high thoracic or cervical injuries may lead to neurogenic shock. Early identification of the injury and appropriate management results in improved outcome, reducing disability and costs of long-term management.

scholarly journals THORACOLUMBAR SPINAL ARTHRODESIS - EPIDEMIOLOGY AND COSTS

2017 ◽  
Vol 16 (1) ◽  
pp. 52-55
Author(s):  
TOBIAS LUDWIG DO NASCIMENTO ◽  
LUIZ PEDRO WILLIMANN ROGÉRIO ◽  
MARCELO MARTINS DOS REIS ◽  
LEANDRO PELEGRINI DE ALMEIDA ◽  
GUILHERME FINGER ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neurological Deficit ◽  
Traffic Accidents ◽  
Thoracolumbar Spine ◽  
Hospital Costs ◽  
Spine Fracture ◽  
Female Ratio ◽  
Cord Injury ◽  
Fall From Height

ABSTRACT Objective: To describe the epidemiology of patients with thoracolumbar spine fracture submitted to surgery at Hospital Cristo Redentor and the related costs. Methods: Prospective epidemiological study between July 2014 and August 2015 of patients with thoracolumbar spine fracture with indication of surgery. The variables analyzed were sex, age, cost of hospitalization, fractured levels, levels of arthrodesis, surgical site infection, UTI or BCP, spinal cord injury, etiology, length of stay, procedure time, and visual analog scale (VAS) . Results: Thirty-two patients were evaluated in the study period, with a mean age of 38.68 years. Male-female ratio was 4:1 and the most frequent causes were fall from height (46.87%) and traffic accidents (46.87%). The thoracolumbar transition was the most affected (40.62%), with L1 vertebra involved in 23.8% of the time. Neurological deficit was present in 40.62% of patients. Hospital stay had a median of 14 days and patients with neurological deficit were hospitalized for a longer period (p<0.001), with an increase in hospital costs (p= 0.015). The average cost of hospitalization was U$2,874.80. The presence of BCP increased the cost of hospitalization, and patients with spinal cord injury had more BCP (p= 0.014) . Conclusion: Public policies with an emphasis on reducing traffic accidents and falls can help reduce the incidence of these injuries and studies focusing on hospital costs and rehabilitation need to be conducted in Brazil to determinate the burden of spinal trauma and spinal cord injury.

Neurological Improvement Associated with Late Decompression of the Thoracolumbar Spinal Cord

Neurosurgery ◽  
1984 ◽  
Vol 14 (3) ◽  
pp. 302-307
Author(s):  
J. Maiman Dennis ◽  
J. Larson Sanford ◽  
C. Benzel Edward
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Canal ◽  
Spinal Instrumentation ◽  
Spinal Fixation ◽  
Neurological Improvement ◽  
Fixation Devices ◽  
Cord Injury ◽  
Spinal Fixation Devices ◽  
Premature Removal

Abstract We reviewed the cases of 20 patients admitted to our institution with thoracolumbar spinal cord injury who had previously undergone laminectomy and/or spinal instrumentation. Thirteen patients had a mass in the spinal canal, and 7 had kyphotic deformities. The lateral extracavitary approach to the spine and posterior stabilization when indicated were done in each. Seventeen patients obtained substantial neurological improvement. All 7 patients with kyphosis regained the ability to walk, as did all but 3 of the nonambulatory patients with a mass in the spinal canal. Morbidity was limited to pneumothorax and 1 case of late kyphosis associated with premature removal of the spinal fixation devices. Elective anterior approaches for reconstruction of the spinal canal with appropriate stabilization afford the best opportunity for neurological improvement in cases of thoracolumbar spinal cord injury.

scholarly journals Different Traumatic Spinal Column Fractures and Traumatic Spinal Cord Injury: An Epidemiologic Study

2020 ◽  
Vol 7 (2) ◽  
pp. 67-72
Author(s):  
Ali Andalib ◽  
◽  
Hossein Akbari Aghdam ◽  
Emran Ahmadi ◽  
◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Epidemiologic Study ◽  
Spinal Column ◽  
Traumatic Spinal Cord Injury ◽  
Spine Fractures ◽  
Road Accidents ◽  
Traumatic Injuries ◽  
Traumatic Lesion ◽  
Cord Injury

Background: Trauma and traumatic injuries are the most common causes of disabilities among the young population in developing countries. Besides morbidity and mortality, traumatic injuries can significantly decrease the quality of life and life expectancy of the victims. Objectives: Traumatic Spinal Cord Injury (TSCI) is an acute, traumatic lesion of the spinal cord. It usually produces economic problems that can emotionally and psychologically affect the patients. This study aims to evaluate spinal column fractures and TSCI in Iran. Methods: In this study, we evaluated all of the cases diagnosed with TSCIs between 2012 and 2018. A total of 1014 patients were included in our study. Prevalence of spinal column fractures was evaluated and the percentage of each type of fractures was extracted. The need for surgery and the percentage of TSCI were also evaluated. Results: The most common cause of trauma was vehicle and road accidents (83.4%) followed by falling (12.7%). A total of 21 patients (2.1%) died due to injuries. The incidence of TSCI among patients with traumatic spinal column fractures were 62 cases (6.1%). Also, 67.7% of patients with TSCI underwent surgery. Furthermore, we found that the lumbar area received the highest incidence of TSCI (38.3% of all TSCIs) followed by thoracic spine fractures (27.4% of all TSCIs). Also thoracic and cervical spine fractures were mostly associated with mortality compared with other sites of spine fractures (47.6% and 38.1% of all mortalities, respectively). Conclusion: In our study, most cases (83.4%) were injured by road accidents which indicates the low safety of vehicles and roads in Iran. Epidemiological features of spinal column injuries and TSCI vary among different societies due to different causes. So far, this study is the first one to evaluate different spine fractures and TSCI and other associated factors in the Iranian population.The results indicate a high incidence of thoracic and lumbar fractures and a higher mortality rate in thoracic and cervical fractures.

Health care burden of cervical spine fractures in the United States: analysis of a nationwide database over a 10-year period

2010 ◽  
Vol 13 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Ali A. Baaj ◽  
Juan S. Uribe ◽  
Tann A. Nichols ◽  
Nicholas Theodore ◽  
Neil R. Crawford ◽  
...  
Keyword(s):  
Health Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spine ◽  
Adverse Outcomes ◽  
Spine Fractures ◽  
Cord Injury ◽  
The Us ◽  
Discharge Status ◽  
Cervical Spine Fractures

Object The objective of this work was to search a national health care database of patients diagnosed with cervical spine fractures in the US to analyze discharge, demographic, and hospital charge trends over a 10-year period. Methods Clinical data were derived from the Nationwide Inpatient Sample (NIS) for the years 1997 through 2006. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. Patients with cervical spine fractures with and without spinal cord injury (SCI) were identified using the appropriate ICD-9-CM codes. The volume of discharges, length of stay (LOS), hospital charges, total national charges, discharge pattern, age, and sex were analyzed. National estimates were calculated using the HCUPnet tool. Results Approximately 200,000 hospitalizations were identified. In the non-SCI group, there was a 74% increase in hospitalizations and charges between 1997 and 2006, but LOS changed minimally. There was no appreciable change in the rate of in-hospital mortality (< 3%), but discharges home with home health care and to skilled rehabilitation or nursing facilities increased slightly. In the SCI group, hospitalizations and charges increased by 29 and 38%, respectively. There were no significant changes in LOS or discharge status in this group. Spinal cord injury was associated with increases in LOS, charges, and adverse outcomes compared with fractures without SCI. Total national charges associated with both groups combined exceeded $1.3 billion US in 2006. Conclusions During the studied period, increases in hospitalizations and charges were observed in both the SCI and non-SCI groups. The percentage increase was higher in the non-SCI group. Although SCI was associated with higher adverse outcomes, there were no significant improvements in immediate discharge status in either group during the 10 years analyzed.

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